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Biomedical subjects

B S Ang

Publications and source records attributed to B S Ang.

12 recordsLinked to original sources
PubMed2001

Melioidosis splenic abscess--an unusual presentation as osteomyelitis of rib.

INTRODUCTION: We report an unusual case of splenic melioidosis abscess presenting as osteomyelitis. CLINICAL PICTURE: A 74-year-old nondiabetic gentleman presents with a non-healing left chest wall abscess from osteomyelitis. TREATMENT: He underwent rib resection and the infection was found to involve the underlying pleura, lung, adjacent stomach, liver and diaphragm with a splenic abscess. Splenectomy was performed. Histology showed suppurative granulomas and cultures grew Burkholderia pseudomallei. OUTCOME: The patient recovered well with antibiotics. CONCLUSION: Melioidosis should not be forgotten as a cause of chronic suppurative infections in our endemic population.

Abscess↗
PubMed2001

Clinics in diagnostic imaging (57). Melioidotic prostatic abscess.

A 46-year-old previously healthy man presented with urosepsis and lower urinary tract obstruction. Both urine and blood cultures grew Burkholderia pseudomallei. Intravenous Ceftazidime failed to control the infection. Prostatic abscess formation was first detected by transrectal ultrasonography, and the extent was subsequently delineated by computed tomography. The abscess was drained by transurethral resection, which served to eradicate a possible persistent focus of infection. The diagnosis and management of prostatic abscess, and Melioidosis infection, are discussed.

Abscess↗
PubMed2001

Bugs for the next century: the issue of antibiotic resistance.

OBJECTIVE: To address the issue of emerging antibiotic resistance and examine which organisms will continue to pose problems in the new century. METHODS: Review of articles pertaining to bacteria recognised for increasing resistance. RESULTS: Changing resistance patterns are correlated with patterns of antibiotic use. This results in fewer effective drugs against "old" established bacteria e.g. gram-positives such as Streptococcus pneumoniae and Staphylococcus aureus. Resistance in gram-negative bacteria is also steadily increasing. Nosocomial gram-negative bacteria are capable of many different resistance mechanisms, often rendering them multiply-resistant. Antibiotic resistance results in morbidity and mortality from treatment failures and increased health care costs. CONCLUSION: Despite extensive research and enormous resources spent, the pace of drug development has not kept up with the development of resistance. As resistance spreads, involving more and more organisms, there is concern that we may be nearing the end of the antimicrobial era. Measures that can and should be taken to counter this threat of antimicrobial resistance include co-ordinated surveillance, rational antibiotic usage, better compliance with infection control and greater use of vaccines.

Anti-Bacterial Agents↗
PubMed2000

Nipah viral encephalitis or Japanese encephalitis? MR findings in a new zoonotic disease.

BACKGROUND AND PURPOSE: An epidemic of suspected Japanese encephalitis occurred in Malaysia in 1998-1999 among pig farmers. In neighboring Singapore, an outbreak occurred among pig slaughterhouse workers. It was subsequently established that the causative agent in the outbreak was not the Japanese encephalitis virus but a previously unknown Hendra-like paramyxovirus named Nipah virus. METHODS: The brain MR images of eight patients with Nipah virus infection were reviewed. All patients tested negative for acute Japanese encephalitis virus. Seven patients had contrast-enhanced studies and six had diffusion-weighted examinations. RESULTS: All patients had multiple small bilateral foci of T2 prolongation within the subcortical and deep white matter. The periventricular region and corpus callosum were also involved. In addition to white matter disease, five patients had cortical lesions, three had brain stem involvement, and a single thalamic lesion was detected in one patient. All lesions were less than 1 cm in maximum diameter. In five patients, diffusion-weighted images showed increased signal. Four patients had leptomeningeal enhancement and four had enhancement of parenchymal lesions. CONCLUSION: The brain MR findings in patients infected with the newly discovered Nipah paramyxovirus are different from those of patients with Japanese encephalitis. In a zoonotic epidemic, this striking difference in the appearance and distribution of lesions is useful in differentiating these diseases. Diffusion-weighted imaging was advantageous in increasing lesion conspicuity.

Abattoirs↗
PubMed1997

Clinical characteristics and natural history of human immunodeficiency virus infected patients seen at a general hospital in Singapore.

The number of patients with human immunodeficiency virus (HIV) infection in Singapore has risen over the years. A considerable proportion of them present with acquired immunodeficiency syndrome (AIDS). In this study, we document the clinical characteristics and natural history of a consecutive series of 50 patients who were found to have HIV infection when they were seen at a tertiary care hospital. The majority were in the 30 to 49 age group and the most common mode of acquisition was heterosexual contact. The patients presented with a variety of symptoms to 11 different clinical departments. Fifty-eight per cent of the patients had AIDS-defining illnesses at presentation, with Pneumocystis carinii pneumonia being the most common. On follow-up, the most frequently occurring opportunistic infection that developed was Cytomegalovirus retinitis. Most patients had multiple subsequent admissions--for both AIDS-defining and non AIDS-defining conditions. The median CD4 count of the cohort at presentation was 72/mm3. The median survival was 399 and 822 days in those who had and those who did not have an AIDS-defining illness at presentation, respectively. Mortality was most commonly attributed to pneumonia. HIV infection has protean manifestations and patients may present to various specialty departments; hence, doctors need to be aware of the spectrum of disease in order to make a diagnosis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Bronchoscopy in immunocompromised host with pulmonary infiltrates.

Pulmonary complications related to immunosuppression may be secondary to infection, neoplasia, toxic effects of chemotherapy and radiotherapy or the primary disease itself. The diagnostic yield from bronchoscopic studies on immunocompromised hosts (ICH) with pulmonary infiltrates varies widely and the indication and timing for bronchoscopic procedures remain uncertain. We prospectively studied 60 consecutive ICH with pulmonary lesions over a 12-month period. Bronchoscopic studies were performed as soon as pulmonary lesions were detected and within 72 hours of antimicrobial treatment. The patients were divided into two groups: E (40 patients) and L (20 patients) were bronchoscoped on average 1.6 days (SD 0.8) and 16.7 days (SD 10.8) respectively after clinical detection and antimicrobial treatment. A total of 131 bronchoscopic procedures were performed. These included bronchoalveolar lavage 60, bronchoscopic lung biopsy 47, bronchial biopsy 8, brushing 8 and washing 8. Diagnostic yields for bronchoscopically obtained fluid and tissue histology were 45% and 49% respectively. Both complement each other resulting in a higher diagnostic yield of about 70% of the patients in both groups. Procedural complications were minor (13% of cases) and mortality was zero. Infections accounted for approximately two-thirds of the pulmonary lesions. Patients bronchoscoped earlier received less antimicrobial empiric therapy and had shorter hospitalisation. Despite delayed bronchoscopy in ICH in the late group, bronchoscopic results influenced in 85% of patients. However, based on earlier use of appropriate therapy, shorter hospitalisation and decreased costs, we recommend early bronchoscopy when response to empiric treatment has been unsatisfactory.

Adolescent↗
PubMed1995

Urinary tract infections.

Urinary tract infections are common clinical problems which result in significant morbidity and even mortality. UTI's can range from minimal disease to life-threatening sepsis and it is important to differentiate between the former which usually involves the lower urinary tract and the latter which invariably involves the upper urinary tract. Diagnosis depends on an abnormal urine microscopy and demonstration of bacteria in the urine. Pre-therapy urine cultures are not mandatory in young women with uncomplicated UTI and many studies support the efficacy of short-course therapy in this groups of patients. For other patients, microbiological and radiological investigations are required and there is insufficient data to support short course therapy in these patients. Treatment guidelines are different in special situations such as prostatitis, pregnancy, catheter-related infection and recurrent infections.

Acute Disease↗
PubMed1993

Candidemia from a urinary tract source: microbiological aspects and clinical significance.

Twenty-six cases of candidemia associated with a well-defined urinary tract source were retrospectively identified and reviewed. Urinary tract abnormalities were present in 23 of 26 patients (88%), 19 (73%) of whom had urinary tract obstruction. Nineteen patients had undergone urinary tract procedures before the onset of candidemia. Episodes of candidemia were brief and low-grade in intensity (median duration, 1 day; median colony count, 1.5 cfu/10 mL of blood). Only eight patients (31%) received > or = 500 mg of amphotericin B. There were five in-hospital deaths (19%); two of these deaths were attributed to candidiasis. No late complications of candidemia were documented for the surviving patients. Patients with urologic pathology and candiduria who undergo surgery or manipulation of the urinary tract are at significant risk for candidemia, and further studies should examine the issue of administration of prophylaxis to this group.

Adolescent↗
PubMed1992

The prevalence of invasive candidiasis in patients with extensive burns.

A retrospective study of patients admitted to the Singapore General Hospital Burn Unit with > 30% total body surface area burns was performed to establish the prevalence of fungal colonisation and invasive fungal disease (IFD). Forty-eight percent of patients surviving at least ten days following thermal injury had fungi isolated. IFD was documented in ten patients. Risk factors associated with the development of IFD, clues to assist in diagnosing IFD, and therapeutic options for managing IFD are reviewed.

Acute Disease↗
PubMed1991

Pulmonary alveolar proteinosis--a case report.

Pulmonary alveolar proteinosis is a relatively rare disease. Its etiology is unknown but it has been found associated with various opportunistic infections as well as immunological conditions. The clinical and radiological features may be indistinguishable from other respiratory disorders and diagnosis is often dependent on histology. Its course can vary from progressive deterioration to spontaneous improvement and treatment with bronchopulmonary lavage may not always be necessary. Many theories regarding pathogenesis have been put forward and most of these centre upon the roles of alveolar macrophages. We describe a case of Pulmonary Alveolar Proteinosis in a local Oriental male and reviewed the current understanding of its pathogenesis.

Humans↗
PubMed1990

Melioidosis: epidemiology and antibiogram of cases in Singapore.

There has been an increased incidence of melioidosis in Singapore. The disease affects mainly males, older patients and a disproportionately higher number of Indians and Malays. Possible predisposing illness include diabetes mellitus. Most patients are bacteraemic. Mortality rate is 72% for bacteraemic patients, as compared to 32% for non-bacteraemic patients. Local strains of Pseudomonas pseudomallei have been consistently sensitive to ceftazidime, chloramphenicol and piperacillin, and nearly always sensitive to tetracycline.

Adolescent↗